Provider Demographics
NPI:1740348283
Name:NORSTED, BONNIE INEZ (MA)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:INEZ
Last Name:NORSTED
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:BONNITA
Other - Middle Name:INEZ
Other - Last Name:NORSTED MEITZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:277 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUUITE308
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5843
Mailing Address - Country:US
Mailing Address - Phone:763-784-3405
Mailing Address - Fax:763-717-4954
Practice Address - Street 1:277 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 308
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5843
Practice Address - Country:US
Practice Address - Phone:763-784-3405
Practice Address - Fax:763-717-4954
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNOA369MEOtherBLUE CROSS BLUE SHIELD
MN6260146OtherUBH